ABSTRACT
A 43-year-old woman visits you for a routine appointment at the surgery. A cursory look at her notes tells you that she has three children, the youngest of whom is 10 years old. She is generally fi t and well, takes loratadine for hay fever in the summer and has no allergies. Following the birth of her last child, she was put on the injectable contraceptive medroxyprogesterone acetate (Depo-Provera) and has been on this for 3 years. She recently opted for a ‘well-woman check’, which was being off ered by a private company for a 50% Christmas discount. She brings the report with her, as she has been asked to discuss a few of the results with you. Th e main result of concern is her dual-energy X-ray absorptiometry (DEXA) scan result. You note this, along with some other relevant results:
DEXA scan result T-score Z-score AP spine –0.9-2.0 Left femoral neck –3.0-3.5 Total hip –2.2-2.9
FRAX® WHO Fracture Risk Assessment Tool (FRAX) 10-year fracture risk calculation Major osteoporotic fracture 12% Hip fracture 4.3% FSH 146.6 iu/L (postmenopausal level 25.8-134.8) LH 90.7 iu/L (postmenopausal level 7.7-58.5) Oestrogen 90 pmol/L (postmenopausal level <200) TSH 2.31 mIU/L (0.3-5.0) Serum calcium 2.30 mmol/L (2.15-2.55) Vitamin D 48 nmol/L (50-74) Weight 60 kg Height 165 cm BMI 22
On further questioning, she advises she has never suff ered a fracture. She tells you that her periods stopped at the age of 38. She did not fi nd this troublesome, as her mother went through the menopause at the age of 40. She was not keen on HRT due to all the health scares and decided to manage her vasomotor symptoms with complementary therapy, which she found worked well for her on most days. She is a non-smoker, takes regular exercise and drinks alcohol on social occasions.
